A J Joseph

Christian Medical College & Hospital, Ludhiana, Punjab, India

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Publications (18)26.96 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Primary hyperparathyroidism is a rare cause of acute pancreatitis. Five consecutive patients with acute or recurrent acute pancreatitis and primary hyperparathyroidism were included. All patients had elevated serum calcium on admission and high levels of circulating parathyroid hormone. Both ultrasonography and Sestamibi scan was used to localize parathyroid adenoma. Except for one, all patients underwent parathyroidectomy and postoperative histology was consistent with parathyroid adenoma. One patient died while on treatment. Metabolic causes of acute pancreatitits, though uncommon, are important as early recognition helps management and prevents recurrence.
    Indian Journal of Gastroenterology 01/2014;
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    ABSTRACT: To evaluate the etiology, presentation, complications and management of chronic pancreatitis in children. Retrospective chart review. Gastroenterology department at Christian Medical College and Hospital, Vellore, India between period January 2005 and December 2010. 99 Children diagnosed with chronic pancreatitis based on clinical and imaging features with age of onset of symptoms below 18 years. Etiology, clinical presentation, complications and management of chronic pancreatitis in children. Of 3887 children who attended the Gastroenterology department, 99(2.5%) had chronic pancreatitis. Among children with chronic pancreatitis 60 (60.6%) were males. In 95(95.9%) patients no definite cause was detected and they were labeled as Idiopathic chronic pancreatitis. All patients had abdominal pain, while 9(9.1%) had diabetes mellitus. Of the 22 children tested for stool fat, 10(45.5%) had steatorrhea Pancreatic calcification was seen in 69 (69.7%). Sixty eight (71.6%) patients with idiopathic chronic pancreatitis had calcification. Calcific idiopathic chronic pancreatitis was more frequent in males (67.6% compared to 48.1%, P=0.07), and was more commonly associated with diabetes mellitus (13.2% vs. none, P=0.047) and steatorrhea (61.5% vs. 16.7%, P=0.069). Pseudocyst n=17(17.1%) and ascites n=9(9.1%) were the most common complications. All children were treateJd with pancreatic enzyme supplements for pain relief. Fifty seven patients followed up.With enzyme supplementation pain relief was present in 32 (56.1%) patients. Of those who did not improve, 10 underwent endotherapy and 15 underwent surgery. Follow up of 8 patients who underwent endotherapy, showed that 5 (62.5%) had relief. Follow up of 11 patients who underwent surgery showed that only 3 (27%) had pain relief. There was no death. Idiopathic chronic pancreatitis is the predominant form of chronic pancreatitis in children and adolescents. It can present with or without calcification. The calcific variety is an aggressive disease characterized by early morphological and functional damage to the pancreas.
    Indian pediatrics 05/2013; · 1.04 Impact Factor
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    ABSTRACT: BACKGROUND AND AIM: Over the last few decades, epidemiologic studies from the West have shown changing trends in etiology and clinical outcomes in patients with nonvariceal upper gastrointestinal bleed (NVUGIB). There are limited data from India on the current status of NVUGIB. The aim of this study therefore was to assess the etiological profile and outcomes of patients with NVUGIB at our center. METHODS: We prospectively studied all patients (≥15 years) who presented with NVUGIB over a period of 1 year. The clinical and laboratory data, details of endoscopy, and course in hospital were systematically recorded. Outcome measures assessed were rebleeding rate, surgery, and mortality. RESULTS: Two hundred and fourteen patients (age, ≥15 years) presented to us with NVUGIB during the study period. The mean age was 49.9 ± 16.8 years and 73.8 % were males. Peptic ulcer was the commonest cause (32.2 %) of NVUGIB. About one third of patients required endoscopic therapy. Rebleeding occurred in 8.9 % patients, surgery was required in 3.7 %, and mortality rate was 5.1 %. Rebleeding and mortality were significantly higher among inpatients developing acute NVUGIB compared to those presenting directly to the emergency room. CONCLUSIONS: Peptic ulcer was the most common cause of NVUGIB. Outcomes (rebleed, surgery, and mortality) at our center appear similar to those currently being reported from the West.
    Indian Journal of Gastroenterology 03/2013;
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    ABSTRACT: Objective: A number of imaging modalities have been used in the preoperative localization of insulinomas. CT is the modality that is in widespread use. Endoscopic ultrasound (EUS) allows the transducer to be placed in close proximity to the pancreas, thereby yielding images of higher quality, leading to accurate localization. An accurate preoperative localization results in minimal invasive surgery and a lower occurrence of residual tumours translating into a better clinical outcome.Methods: We analyzed the hospital records of all adult patients (age > 18 yrs), who were diagnosed to have insulinoma, over a period of 6 yrs, from Oct 2004 to Sept 2010. The diagnosis was based on the clinical practice guidelines of the American Endocrine Society. The sensitivity of EUS was compared with MDCT in localization of the lesion.Results: Eighteen patients were seen over a period of 6 years, from 2004 to 2010. EUS was conducted in all 18 patients. Multi-detector CT scans were carried out in 17 patients. EUS had greater sensitivity (89%)in localizing insulinomas in comparison to CT (69%). In this series, the lesions which were missed on CT, but were picked up on EUS were smaller (less than 12 mm, p = <0.001). Lesions which were close to the mesenteric vessels and those located in the head of the pancreas were more likely to be missed on CT.Conclusions: EUS has a greater sensitivity in identifying and localizing insulinomas preoperatively. With increasing availability, the EUS should be part of a preoperative insulinoma workup.
    Endocrine Practice 02/2013; · 2.49 Impact Factor
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    ABSTRACT: Single balloon enteroscopy (SBE) is a recently developed diagnostic modality to assess small bowel mucosa. The data on learning curve of SBE is scanty. We aimed to assess the learning curve, diagnostic yield and safety of SBE. All patients who underwent SBE at our centre from December 2007 to December 2010 were included retrospectively. The clinical details, enteroscopy findings and procedure related details were obtained for each patient from a prospectively maintained database. The extent of small bowel visualised with increasing number of procedures by a single endoscopist (Endoscopist A) who performed most of the procedures was used to estimate the learning curve using locally weighted regression curve. The diagnostic yield and complications rates of SBE were also estimated. The study was approved by the institute review board and ethics committee. Ninety SBEs were performed in 84 patients (age: 42+15 years, 27.4% females). 57 procedures were performed (32 antegrade and 25 retrograde) by endoscopist A. There was gradual improvement in the extent of small bowel visualised during the first 15 procedures via antegrade route followed by flattening of curve. The retrograde route showed no definite trend towards improvement during the procedures performed. The overall diagnostic yield of SBE was 32.1%. There was no complication except for mild self-limiting abdominal pain in one patient. SBE via antegrade route has a higher success rate and better learning curve than the retrograde route. SBE is a safe procedure and helps in establishing a diagnosis in one-third of the patients examined.
    Tropical gastroenterology: official journal of the Digestive Diseases Foundation 01/2012; 33(3):179-84.
  • Tropical gastroenterology: official journal of the Digestive Diseases Foundation 01/2012; 33(1):67-9.
  • Gut 03/2010; 59(3):291, 347. · 10.73 Impact Factor
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    Indian Journal of Gastroenterology 01/2010; 29(1):40.
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    ABSTRACT: This study aimed at evaluating the single nucleotide polymorphisms (SNPs) in five cytokine genes regulating inflammation at altogether 8 different loci and compared their frequencies in patients with Irritable bowel syndrome (IBS) versus healthy age and sex matched controls. Peripheral blood was collected for DNA cytokine analysis from 23 patients with lBS and 20 healthy controls. The cytokine SNPs studied include TNF-alpha (-308G/A), TGF-alpha1 (codon10T/C, codon25G/C), IL-6 promoter (-1082A/G; -819T/C; -592A/C), IL-6 promoter (-174G/C), and IFN-alpha (+874T/A). There was a significant difference between a SNP in IL-b (-592A/C) among cases and controls. There was also a trend to significance as regards to IL-6 promoter (-174G/C). Frequencies of other SNPs were not significantly different between the two groups. This pilot study shows that there are polymorphism differences in cytokine genes between patients with lBS and healthy controls from India.
    Tropical gastroenterology: official journal of the Digestive Diseases Foundation 01/2010; 31(1):30-3.
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    ABSTRACT: Western studies show that up to 65 per cent of patients with Crohn's disease have low serum 25-hydroxy vitamin D concentrations, and 45 per cent of these patients have metabolic bone disease. No data are available from India or from any country with comparable climatic conditions or ethnicity. We carried out this study to measure the serum 25 (OH) vitamin D levels of Crohn's disease patients and compare with matched controls and to assess the consequences of low 25 (OH) vitamin D levels on bone and mineral metabolism in these patients. Adult patients with Crohn's disease were compared with age and sex matched patients diagnosed to have irritable bowel syndrome. Serum 25 (OH) vitamin D, the effect of disease characteristics, sunlight exposure and milk consumption on 25 (OH) vitamin D level, and the consequences of low 25 (OH) vitamin D level on bone and mineral metabolism were assessed. Thirty four patients with Crohn's disease (M:F, 24:10, age 39.2 +/- 12.9 yr) and 34 controls (M:F, 24:10, age 38.9 +/- 13.4 yr) were studied. 25 (OH) vitamin D levels were significantly lower in patients with Crohn's disease as compared to controls (Crohn's disease vs controls: 16.3 +/- 10.8 vs 22.8 +/- 11.9 ng/ml; P<0.05). The severity of disease activity as assessed by the Harvey Bradshaw score correlated negatively (Correlation coefficient -0.484, significance P<0.004), and the duration of sunlight exposure correlated positively (Correlation coefficient 0.327, significance P=0.007) with the serum 25 (OH) vitamin D level. Serum 25 (OH) vitamin D levels were significantly lower among patients with Crohn's disease as compared to age and sex matched controls. Further, 25 (OH) vitamin D levels in patients with Crohn's disease were lower in those with severe disease activity and less sun exposure. Further studies need to be done to correlate low 25 (OH) vitamin D level with bone density and assess the effect of vitamin D supplementation in these patients.
    The Indian Journal of Medical Research 08/2009; 130(2):133-7. · 2.06 Impact Factor
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    ABSTRACT: The aetiological profile of paediatric portal hypertension in our hospital, a tertiary care centre in South India, showed that the commonest causes were extrahepatic portal venous obstruction (EHPVO) and cirrhosis. Wilson's disease was the most common cause of cirrhosis.
    Tropical Doctor 02/2009; 39(1):42-4. · 0.61 Impact Factor
  • Case Reports. 01/2009; 2009.
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    ABSTRACT: Human T cell lymphotropic virus type 1 (HTLV-1) infection is a risk factor for Strongyloides stercoralis infection. HTLV-1 also predisposes to the development of T cell malignancies. We report a case of a patient with severe, treatment resistant Strongyloides infection and HTLV-1 infection who progressed to develop an advanced high grade T cell lymphoma of the intestine.
    Case Reports 01/2009; 2009.
  • Journal of Gastroenterology and Hepatology 10/2008; 23(9):1463. · 3.33 Impact Factor
  • Gastrointestinal endoscopy 09/2008; 69(3 Pt 1):593-5. · 6.71 Impact Factor
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    ABSTRACT: Spontaneous rupture of amyloid liver is a fatal complication. A 48-year-old man with systemic amyloidosis secondary to multiple myeloma presented with acute hemoperitoneum. Emergency angiogram showed extravasation of contrast from the liver into the sub-hepatic space, which was successfully stopped by embolization of the right hepatic artery.
    Indian Journal of Gastroenterology 01/2004; 23(1):26-7.
  • A Chacko, A Joseph
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    ABSTRACT: The world’s elderly population is fast increasing. But there is scant information of their health needs in the developing countries. This study is an attempt to estimate their health problems. 197 persons aged 60 years and above were interviewed from 3 villages of Kaniyambadi Block, North Arcot District, and Tamil Nadu. The total Population of the villages was 4256, of which 240 (5.6 %) were those aged 60 years and above. Among the elderly, 80% of the women and 20% of the men were widowed. The majority of them (55%) had visual problems (cataract), followed by orthopaedic problems. Chronic respiratory disorders were significantly more in men while orthopaedic problem were more in women. Of these 15.6% were hypertensive, 8.6% mainly widows needed assistance in physical activities like bathing, toilet, and dressing, walking and eating. These findings were similar to the studies on the elderly done in the West, and demonstrate an urgent need towards planning for the elderly in India
    Indian Journal of Community Medicine. 01/1990;
  • R Jeyamani, A J Joseph, A Chacko
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    ABSTRACT: The association between severe and persistent strongyloidiasis with human T cell lymphotropic virus type I (HTLV-1) infection is well documented in reports from HTLV-1 endemic regions like Japan and Jamaica. But there are no reports from non-endemic areas like India. We report a case of severe intestinal strongyloidiasis in a 45-year old Keralite man, living in Sikkim. Despite standard treatment with many courses of albendazole, his stool persistently showed Strongyloides stercoralis larvae. In the absence of other immunosuppressive conditions, human T cell lymphotropic virus type I infection was considered and determined positive. Subsequently, treatment with 2 courses of ivermectin achieved eradication of the infection. On follow-up, 3 years later, his stools again revealed Strongyloides stercoralis larvae.
    Tropical gastroenterology: official journal of the Digestive Diseases Foundation 28(4):176-7.

Publication Stats

33 Citations
37 Downloads
842 Views
26.96 Total Impact Points

Institutions

  • 2009–2013
    • Christian Medical College & Hospital
      Ludhiana, Punjab, India
  • 2008–2012
    • Christian Medical College Vellore
      • Department of Gastroenterology
      Velluru, Tamil Nādu, India